Several good comments have been made on this issue.  Yes, we must not
lose sight of the value of hand expression before it bocomes a "lost
art".  I believe it is still the pirmary means of expression in much of
the world.  In our industrialized countries, we tend to over rely on
mechanical/technological solutions when more natural ones may be as good
if not better.  On the other hand, this is a lot easier for some moms
than others.  Some are able to express as quickly if not more so than a
pump, while for others it is a real struggle to get an adequate amount
out.
The question often arises-Doesn't the "poorer" mom deserve the same kind
of help as her more fortunate sister.  Yes, in some families they will
spend what to some of us is an extrordinary amount on the fanciest cribs
etc, but balk at the cost of an effective breast pump.  I'm talking
about the mom who truly has to stretch every penny as far as it will
go.  An option I haven't seen mentioned in this current thread (although
I am a couple digests behind) is the pedal pump.  The Medela one at cost
is just a little over $25.  (I know there is at least one other one
available that claims to work on any piston type pump setup, but I
haven't heard how well it works.)  These can be loaned to moms-should be
no concern about contamination-or "rented" for a $25 deposit that is
returned when the pump is returned.  That way, the agency or hospital or
whatever is only "out" the small difference over $25.  Or you could
charge $30 deposit and the cost is covered it the pump isn't returned.
In the case of a NICU, if baby goes home completely breastfed, the pump
comes back when the baby goes home.  I know one WIC clinic did this a
few years back and found it to be a very viable alternative.

Winnie

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